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      Cardiometabolic and Anthropometric Outcomes of Intermittent Fasting Among Civil Servants With Overweight and Obesity: Study Protocol for a Nonrandomized Controlled Trial

      , MPH, DrPH, MD 1 , , , MBBS 1 , , BSc 1 , , MBCHB, MPH, DrPH 1 , , BSc, MSc 1 , , BEng, MSc 1 , , MB BCh BAO 1 , , BSc, PhD 1 , , MD 1 , , MBBS, MSc 1 , , MD 1 , , MD, MCommHealth 2 , , BSc, MSc, PhD 3 , , BSc 4 , , BSc 4 , , BSc, MSc 2 , , BSc 2 , , MPH, MD 5 , , BSc, MSc, PhD 6 , , BSc, MSc, PhD 1
      (Reviewer), (Reviewer), (Reviewer)
      JMIR Research Protocols
      JMIR Publications
      intermittent fasting, dry fasting, obesity, overweight, healthy plate

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          Overweight and obesity among adults are a growing global public health threat and an essential risk factor for various noncommunicable diseases. Although intermittent fasting is a generally new dietary approach to weight management that has been increasingly practiced worldwide, the effectiveness of 2 days per week dry fasting remains unclear.


          The Cardiometabolic and Anthropometric Outcomes of Intermittent Fasting study aims to determine the cardiometabolic, anthropometric, dietary intake, and quality of life changes among civil servants with overweight and obesity, following combined intermittent fasting and healthy plate (IFHP) and healthy plate (HP) and explore the participants’ experiences.


          We designed a mixed methods quasi-experimental study to evaluate the effectiveness of the IFHP and HP methods among adults with overweight and obesity. A total of 177 participants were recruited for this study, of which 91 (51.4%) were allocated to the IFHP group and 86 (48.6%) to the HP group. The intervention comprised 2 phases: supervised (12 weeks) and unsupervised (12 weeks). Data collection was conducted at baseline, after the supervised phase (week 12), and after the unsupervised phase (week 24). Serum and whole blood samples were collected from each participant for analysis. Data on sociodemographic factors, quality of life, physical activity, and dietary intake were also obtained using questionnaires during data collection.


          Most of the participants were female (147/177, 83.1%) and Malay (141/177, 79.7%). The expected outcomes of this study are changes in body weight, body composition, quality of life, physical activity, dietary intake, and cardiometabolic parameters such as fasting blood glucose, 2-hour postprandial blood glucose, hemoglobin A1c, fasting insulin, and lipid profile.


          The Cardiometabolic and Anthropometric Outcomes of Intermittent Fasting study is a mixed methods study to evaluate the effectiveness of combined IFHP and HP interventions on cardiometabolic and anthropometric parameters and explore participants’ experiences throughout the study.

          Trial Registration

          ClinicalTrials.gov NCT05034653; https://clinicaltrials.gov/ct2/show/NCT05034653

          International Registered Report Identifier (IRRID)


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          Most cited references27

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          International physical activity questionnaire: 12-country reliability and validity.

          Physical inactivity is a global concern, but diverse physical activity measures in use prevent international comparisons. The International Physical Activity Questionnaire (IPAQ) was developed as an instrument for cross-national monitoring of physical activity and inactivity. Between 1997 and 1998, an International Consensus Group developed four long and four short forms of the IPAQ instruments (administered by telephone interview or self-administration, with two alternate reference periods, either the "last 7 d" or a "usual week" of recalled physical activity). During 2000, 14 centers from 12 countries collected reliability and/or validity data on at least two of the eight IPAQ instruments. Test-retest repeatability was assessed within the same week. Concurrent (inter-method) validity was assessed at the same administration, and criterion IPAQ validity was assessed against the CSA (now MTI) accelerometer. Spearman's correlation coefficients are reported, based on the total reported physical activity. Overall, the IPAQ questionnaires produced repeatable data (Spearman's rho clustered around 0.8), with comparable data from short and long forms. Criterion validity had a median rho of about 0.30, which was comparable to most other self-report validation studies. The "usual week" and "last 7 d" reference periods performed similarly, and the reliability of telephone administration was similar to the self-administered mode. The IPAQ instruments have acceptable measurement properties, at least as good as other established self-reports. Considering the diverse samples in this study, IPAQ has reasonable measurement properties for monitoring population levels of physical activity among 18- to 65-yr-old adults in diverse settings. The short IPAQ form "last 7 d recall" is recommended for national monitoring and the long form for research requiring more detailed assessment.
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            Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies.

            A WHO expert consultation addressed the debate about interpretation of recommended body-mass index (BMI) cut-off points for determining overweight and obesity in Asian populations, and considered whether population-specific cut-off points for BMI are necessary. They reviewed scientific evidence that suggests that Asian populations have different associations between BMI, percentage of body fat, and health risks than do European populations. The consultation concluded that the proportion of Asian people with a high risk of type 2 diabetes and cardiovascular disease is substantial at BMIs lower than the existing WHO cut-off point for overweight (> or =25 kg/m2). However, available data do not necessarily indicate a clear BMI cut-off point for all Asians for overweight or obesity. The cut-off point for observed risk varies from 22 kg/m2 to 25 kg/m2 in different Asian populations; for high risk it varies from 26 kg/m2 to 31 kg/m2. No attempt was made, therefore, to redefine cut-off points for each population separately. The consultation also agreed that the WHO BMI cut-off points should be retained as international classifications. The consultation identified further potential public health action points (23.0, 27.5, 32.5, and 37.5 kg/m2) along the continuum of BMI, and proposed methods by which countries could make decisions about the definitions of increased risk for their population.
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              Obesity, eating behavior and physical activity during COVID-19 lockdown: A study of UK adults

              Eating, physical activity and other weight-related lifestyle behaviors may have been impacted by the COVID-19 crisis and people with obesity may be disproportionately affected. We examined weight-related behaviors and weight management barriers among UK adults during the COVID-19 social lockdown. During April–May of the 2020 COVID-19 social lockdown, UK adults (N = 2002) completed an online survey including measures relating to physical activity, diet quality, overeating and how mental/physical health had been affected by lockdown. Participants also reported on perceived changes in weight-related behaviors and whether they had experienced barriers to weight management, compared to before the lockdown. A large number of participants reported negative changes in eating and physical activity behavior (e.g. 56% reported snacking more frequently) and experiencing barriers to weight management (e.g. problems with motivation and control around food) compared to before lockdown. These trends were particularly pronounced among participants with higher BMI. During lockdown, higher BMI was associated with lower levels of physical activity and diet quality, and a greater reported frequency of overeating. Reporting a decline in mental health because of the COVID-19 crisis was not associated with higher BMI, but was predictive of greater overeating and lower physical activity in lockdown. The COVID-19 crisis may have had a disproportionately large and negative influence on weight-related behaviors among adults with higher BMI.

                Author and article information

                JMIR Res Protoc
                JMIR Res Protoc
                JMIR Research Protocols
                JMIR Publications (Toronto, Canada )
                August 2022
                5 August 2022
                : 11
                : 8
                : e33801
                [1 ] Nutrition, Metabolism and Cardiovascular Research Centre, Institute for Medical Research, National Institutes of Health Ministry of Health Shah Alam, Selangor Malaysia
                [2 ] Sector for Biostatistic and Data Repository, National Institutes of Health Ministry of Health Shah Alam, Selangor Malaysia
                [3 ] Institute for Health Behavioural Research, National Institutes of Health Ministry of Health Shah Alam, Selangor Malaysia
                [4 ] Institute for Public Health, National Institutes of Health Ministry of Health Shah Alam, Selangor Malaysia
                [5 ] Occupational Safety and Health Unit, National Institutes of Health Ministry of Health Shah Alam, Selangor Malaysia
                [6 ] Faculty of Fisheries and Food Science, Universiti Malaysia Terengganu Terengganu Malaysia
                Author notes
                Corresponding Author: Shazana Rifham Abdullah shazana.a@ 123456moh.gov.my
                Author information
                ©Shazana Rifham Abdullah, Nur Hayati Azizul, Ruziana Mona Wan Mohd Zin, Nur Suffia Sulaiman, Norhayati Mustafa Khalid, Roshan Jahn Mohd Salim Mullahi Jahn, Muhamad Khairul Nazrin Khalil, Norhashimah Abu Seman, Nur Azlin Zainal Abidin, Azizan Ali, You Zhuan Tan, Azahadi Omar, Mohammad Zabri Johari, Nur Shahida Abdul Aziz, Azli Baharudin, Zamtira Seman, Norazizah Ibrahim Wong, Mona Lisa Md Rasip, Hayati Mohd Yusof, Mohd Fairulnizal Md Noh. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 05.08.2022.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on https://www.researchprotocols.org, as well as this copyright and license information must be included.

                : 24 September 2021
                : 29 March 2022
                : 14 April 2022
                : 11 May 2022

                intermittent fasting,dry fasting,obesity,overweight,healthy plate


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